Tehran University Medical Journal

Background: Post-acrosomal sheath WW domain binding protein (PAWP) is one of sperm factors related to oocyte activation and is expressed in elongating spermatid. Previously, the effect of high of testicular temperature in infertile men with varicocele on semen quality, sperm DNA damage, expression of genes and proteins were reported. In this study, expression of PAWP at RNA and protein levels, and also sperm DNA damage were compared between fertile and infertile men with varicocele.
Methods: In this case-control study, semen samples were collected from 35 infertile men with varicocele (grade II & III) and 20 fertile men referring to Isfahan Fertility and Infertility Center from January 2016 to September 2016. Ejaculated semen was obtained by masturbation into a sterile plastic container after 3-5 days of abstinence and was allowed to liquefy at room temperature. Briefly, sperm concentration, motility and morphology were evaluated using a sperm chamber (Sperm meter; Sperm Processor, Aurangabad, India), Computer Assisted Semen Analysis (CASA, Video Test, ltd: version Sperm 2.1, Russia) and Papanicolaou staining, respectively. In addition, DNA fragmentation, expression of PAWP at RNA and protein levels were assessed by real-time PCR, and Western blot technique, respectively. Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA) and Package for the Social Studies were used to analyze data. We used independent-samples t-test to compare the mean value between different groups. Differences with values of P<0.05 were considered as statistically significant.
Results: Mean of semen volume, sperm concentration, percentage of sperm motility, and expression of PAWP at both RNA (P=0.0001) and protein (P=0.03) levels were significantly lower in infertile men with varicocele in comparison with fertile men. In addition, mean percentage of sperm abnormal morphology and sperm DNA fragmentation were significantly higher in infertile men with varicocele in comparison with fertile men (P<0.05).
Conclusion: Expression of PAWP as a protein involved in spermatogenesis and fertilization process, has decreased in infertile men with varicocele. In addition, sperm DNA integrity was disrupted in these individuals that can be considered as a main etiology of infertility.

Background: In Iran, a combination of three methods of budget payment, fee for service and case-based payment (known as the global payment system) is used to reimburse the cost of hospital services. The aim of this study was to investigate the costs of 90 services of the Global Hospital Reimbursement System at Tehran University of Medical Sciences.
Methods: This descriptive cross-sectional applied study was performed from March  2017 to March 2019 in the hospitals of Tehran University of Medical Sciences. The billing and record data of all patients whose services were reimbursed on a global payment system basis were extracted from hospital information systems. Data were analyzed using descriptive statistics (frequency mean. std deviation, maximum & minimum) in SPSS 21 and Excel 2016.
Results: During two years in TUMS, the costs of services provided to 143,866 patients have been reimbursed based on the global payment system., which had a cost of 2300 billion rials. 80% of the total services and costs were related to 10 services. 78.46% of the cases were related to two specialized groups of ophthalmology and obstetrics and gynecology. 83.17% of the total costs of services reimbursed globally at the TUMS were related to these two specialized groups. The average cost per service was about 16 million Rials, but varied greatly for different services, ranging from about 1.8 million Rials to 67 million Rials. On average, for a global service, the share of each of the cost subgroups of diagnostic services, hoteling and nursing services, medicine and consumables, operating room and surgery, physician's visit and consultation, respectively 3.1%, 11.6%, 21.4%, 49.9% and 13.9%.

Conclusion: Managers need to focus on high-frequency and high-cost services to reduce the cost and financial losses for services that are under the global payment system. Depending on the specific cost pattern of each service, the strategies adopted to control the costs of that service should also be different.